Should transsexuality be freely endorsed
by Christians?

It is shown that transsexuality is not deterministically enforced biologically or genetically, and has a psychological origin, but change to acceptance of ones chromosmal gender may still take a few years to occur in a motivated subject. It is argued that the basic Christian ethic governing the area is derived from passages in which it is said that sexual conduct on earth should reflect ideal sexuality in heaven particularly as exemplified between Christ and his Bride. Hence other forms of sexuality cannot be freely endorsed

In transsexuality persons of one chromosomal gender are very uncomfortable with the behaviour required in that gender. They greatly prefer that they had been born in the other sex, and 1-3% seek corrective surgery, hormone therapy and then live in the new gender. About 10,000 such operations have been performed since the late ’70s (Israel & Tarver, 1997)

The incidence of transsexuality is about 1 in 30,000 for males and 1 in 100,000 for females (Bem, 1993; Anon., 1997; Gallarda et al., 1997) However the incidence for the Netherlands is given as 1 in 11,900 for males and 1 in 30,400 for females (van Kesteren et al., 1996). This may be compared with the (previous) 12 month incidence in the US of exclusive male homosexuality (1%) exclusive lesbianism (0.5) and bisexuality (1.7% and 1.2% respectively; Whitehead & Whitehead, 1999). so that the incidence of transsexuality is about 300 times lower and study correspondingly more difficult.

The origin of transsexuality is not clear. However the feelings of discomfort (gender dysphoria) mostly date from childhood.

There are many associated clinical, biochemical, behavioural and family parameters which may have some connection with the origin of transsexuality. None of these is conclusive: some are suggestive, some are merely obscure.

An example is the report (Bosinski et al., 1997b) in which 83% of female to male transsexuals had higher than normal contents of one or more of a number of male sex hormones. There were no reproducible findings and differences were small.

Physical

There are some reasonably reproducible physical characteristics of transsexuals which are worth reporting (Bosinski et al., 1997b). A significant proportion of female to male transsexuals were more masculine than the average female in body build. Mostly the differences were small. Similarly small differences are found for many lesbians, and in the opposite direction for male homosexuals. The significance is doubtful, but individuals are sometimes very sensitive to these small differences.

Left-handedness in transsexuals of both sexes is about twice normal (Orlebeke et al., 1992). Possibly poor uterine conditions for the developing foetus effect developing organs, but this is speculative. Obviously most transsexuals are not affected.

There are slight male/female differences in visiospatial and verbal abilities of heterosexuals. Males score higher on visio-spatial and females on verbal skills. However the differences are small, and only moderately reproducible. Many studies have not found them. These slight differences are also reflected in transsexuals, and change with hormone treatment appropriate to the target sex (Holden, 1995).

Otoacoustic emission is a particularly interesting phenomenon. Although eardrums are usually considered receptors of sound, they may also emit small noises, mainly in females. This is detectable with appropriate instruments. During treatment of male to female transsexuals with female sex hormones, these emissions may be detected for the first time (McFadden et al., 1998).

A study of female to male transsexuals showed a high rate of various physical disorders, which might connect with their desire to change sex (Bosinski et al., 1997a). 6/16 of the study group had non-classical congenital adrenal hyperplasia. This condition comprises an over active adrenal gland, producing male sex hormones, which partly masculinise the foetus before birth. The child, if female, is born with a greatly enlarged clitoris, resembling a small penis. If untreated, masculinisation may increase, and although the child has ovaries and a uterus, the body may take the male form. Treatment with cortisone is routine these days and prevents the masculinisation and enables the girl to mature as a female, marry, and give birth. The condition makes the girls feel doubtful about their sexuality however, and could easily give rise to ideas of being a person of the other sex trapped in the wrong body.

It could be argued that the transsexual may be hormonally normal but have brain structure differences which are appropriate to the other sex, as claimed by some Dutch authors (Zhou et al., 1995). The volume of the central subdivision of a part of the brain, known as the bed nucleus of the stria terminalis (BSTc), is larger in men than women and is female sized in male to female transsexuals, or even smaller than the size in females. This was found by examination of the brains of transsexuals who had died. It was the same size for homosexual and heterosexual men, but there was considerable variation. 2 Heterosexual men overlapped the range for transsexuals. All the transsexuals had taken oestrogen for long periods, but had stopped a few months before death, and all had taken antiandrogens, which decrease the effects of androgens on the body. The significance of all this is not clear, but the hormonal treatment could have had some effect on the size of the structures.

However a 31 year old man with a feminising tumour still had the same sized brain region as other males so that this argues against the effect of sex hormones being important. It was also known that removal of the testes had no effect on the size, so male hormones had little effect. The size does not change in post menopausal women, lack of female hormones had no effect. The authors hypothesised that there could be a specific anomaly in transsexuals which strongly influenced the transsexual desire, but emphasised the study was preliminary.

Studies such as this are well known in the field of study of homosexual orientation, and have been particularly thoroughly reviewed by Byne and Parsons (1993), who comment that very few of such studies have been shown to be replicable in the past. Various slight differences in the structures in the brain, particularly the hypothalamus (also involved here) are hypothesised to show differences in sexual orientation. However these studies are very difficult, and very difficult to reproduce; the reliability of the results is low.

Even if a result proves to be reproducible it is of little value in proving that it has changed the behaviour of the subject. This is because the brain structures change in response to training, experiences and behaviours (Kandel & Hawkins, 1992). One of the authors of Zhou et al (1995), Swaab, agreed that it was not possible to say whether the changed size of the hypothalamus region was the cause or consequence of the transsexuality.

A prominent brain microanatomist, Roger Gorski, thinks stress itself could be involved (Gorman, 1995): “Think about it. These people undergo a lot of emotional trauma. To cut everything off to become a woman has got to be awfully stressful and that has got to affect brain structures”.

The conclusion is that differences in brain structures will probably continue to be found, but this does not show that they force on a person any particular behaviour.

There are various scales which measure masculinity and femininity, the best known dating from the early ’70s (PAQ scale, Bem scale and MMPI-2). On the latter (a subscale of the well known Minnesota Multiple Personality Inventory), transsexuals who are contemplating a change from male to female score on the female end (LaTorre, 1979). The question immediately arises whether they are innately psychologically feminine in a male body. The same result was found in another study (Cole et al., 1997) but that study somewhat confusingly did not show that female to male transsexuals were higher on the masculine end of the scale.

Transsexuals may take various positions on masculinity/femininity scales and fall into a number of sub groups. This is shown in the attached diagram, due to Blanchard (Blanchard, 1985), in which the pre-operative sexual orientations of males were as follows: Heterosexual (attracted to females) 16 (10%), asexual 12 (8%), bisexual 35 (21%), homosexual 100 (61%). In comparison, the respective percentages in a non-clinical randomised sample from the general population would be about 88%, 9%,1.7%, 1.0% (Whitehead & Whitehead, 1999) which is very different. However the reported orientations may be somewhat distorted. It is known that there has been frequent lying by clients to increase their chances of an operation, and this has been particularly severe in the past.

Where the possibility of surgical change is doubtful, an unpublished study (personal comm. J. Leach, Kentucky) on a larger group of several hundred males not seeking re-assignment, reports 80% of subjects are attracted to females rather than the 10% above.

The fact that these orientations are not fixed is shown by literature in which in the course of the operation and subsequent adjustment over 18 months the orientation reversed (Wilchesky et al., 1994; Daskalos, 1998). In Daskalos, 1998 6/20 male to female transsexuals who were attracted to women claimed their orientation changed so that they were now attracted to males. They thought the course of sex-hormone therapy was partly responsible (but this is clinically very unlikely). In Wilchesky et al., (1994) mainly studying male-to-female transsexuals, the shift (in about the same percentage of cases) was also towards attraction to men. One female-to-male transsexual initially attracted to males, also changed, to be attracted to females. This percentage of changes in orientation is of considerable theoretical importance, adding to the significant literature which exists describing sexual orientation changes under various conditions. The changes in this case (if genuine) are very fast, but may merely be a reversion to the real orientation not presented to the medical personnel..

In connection with sexual orientation it could also be worth mentioning that 10 years post-operatively 40% of male-to-female transsexuals who were originally allegedly attracted to women are reported as attracted to gay men (Sprecher & Sedikides, 1993). There are also some (non-transsexual) men who are almost entirely sexually attracted to the transvestite and sometimes the transsexual (Blanchard & Collins, 1993). This is a sexual orientation not to females, but those who pretend to be female or become that by operation. The attraction is obviously not innate, because it is reacting to the status of those who have undergone an artificial operation.

The degree of adjustment to the new gender post-operatively depends heavily on the degree of social support. In early programmes there was relatively little follow-up and the results were not promising. An investigation into the programme at Johns Hopkins, showed that the degree of gender adjustment was no different for those who had been allowed the operation, compared with those who had not (Meyer and Reter, 1979).

The programme was halted for that and other reasons. Subsequent programmes insisted on a candidate being able to show the ability to pass as a woman for two years before any operation proceeded, and follow-up was enhanced. The results generally show that adjustment is fairly satisfactory, with small percentages dissatisfied (less than 20%, Bodlund & Kullgren, 1996). But this result has been shown to be still dependent on the degree of social support, and female-to-male transsexuals were more satisfied post-operatively than male-to-female transsexuals. This indicates the great importance of social setting. A strong parallel is apparent in the gay world. When a gay comes “out” he is usually surrounded by a group of those already out who help him through the process so intimately, that it amounts to a kind of intellectual conversion.

From being ashamed of himself and his feelings he reverses dramatically to believe that (a) he was born that way (b) it is not changeable (c) it is a morally viable condition. Believing these propositions his self-esteem increases dramatically, and his adjustment to his status improves considerably.

The point here is not that adjustment shows the original diagnosis was the correct one, but that social groupings aid adjustment greatly, and that the human psyche is remarkably malleable. In the case of transsexuals therefore, the fact of adjustment post-operatively does not prove the earlier diagnosis of an immutable cross-gender psyche in the client, merely that change in all kinds of directions is always possible.

The origin of the transsexual condition is not clear, and this is expected, given the heterogeneity of the orientations. Because clients present with varying sexual orientation it follows that there could well be several causes. This is similar to the case of homosexuality, which is also believed to have varying origins (Whitehead & Whitehead, 1999). Diamond (Diamond, 1965) thinks that about half of transsexuality is learnt, but the above literature suggests this may be an underestimate. A common feature of transsexuality however is frequent childhood gender non-conformity. This usually precedes puberty and sexual attraction.

There are many and varying family circumstances which may be partly responsible for transsexuality. As for homosexuality, a late birth order is common (Blanchard et al., 1996). It appears that being late, or last, in a family of children is often not optimum. A child may receive less attention from parents, and other siblings may well be dominant. Rather unusual family conditions have sometimes been implicated (Rekers, 1996) In an NIMH program, a survey of 70 clients found no obviously physical symptoms (except one case of an undescended testicle) but 80% of the mothers and 45% of the fathers had psychiatric problems of various types which are very high incidences. For the most gender dysphoric, in all cases the father was absent. Overall in 54% of cases the father was absent, and in 37% of cases there was no adult male role model. If a father or role model was available, in 60% of cases he was psychologically distant. Another common factor was frequent ineptness at sport. The latter can arise from lack of physical co-ordination, but will have strong psychological effects in the highly competitive world of growing boys. Thus there are a constellation of social factors probably involved.

In some cases (pers. comm. J.Leach) sexual abuse may be involved. As in homosexuality, particularly for those subjects in clinical settings, rates of 80% have been recorded. (Whitehead & Whitehead, 1999).

When the condition is connected to other conditions, treatment of the latter sometimes causes the transsexuality to disappear. A case of OCD associated with transsexuality was treated for OCD, but the transsexual symptoms also disappeared for four years.

A case of borderline learning disorder was treated for one year with pimozide, a drug useful in cases of Tourette’s Syndrome (spasmodic physical conditions of various types). Associated transsexuality also remitted for more than a year (Puri & Singh, 1996). These cases are not mainstream, but show the condition is malleable.

The question whether transsexuality is determined, i.e. innate, inescapably forced on people, is best answered by two paths (a) do identical twins always both have the condition? (b) is any change through therapy possible?

Twins have been used in many instances to check whether a condition is inescapable. If a condition is created by the presence of particular genes, then identical twins (who have identical genes, which is why they are such a useful test) who possess such genes will always, infallibly, have the condition. Thus for many genetic diseases, such as haemophilia, if one identical twin has the defective gene, and haemophilia, so will the other. This holds for physical conditions where there is a direct link to genes and gene products. Thus if one identical twin has a condition, and it is inescapably caused by genes, the co-twin will also.

Note however that the twins in most studies are brought up in the same household, and it could be that the social conditions of the upbringing infallibly force both pairs of a twin couple into a medical or mental condition. This would also result in both twins being the same. This makes identical twin studies ambiguous, but does lead to an extremely simple but useful conclusion:

In the case of homosexuality, no modern study has found a concordance for identical twins much greater than 50%. Thus neither their environment nor genes force them into the behaviour, but both contribute. For transsexuality (a rarer condition than homosexuality) far fewer twin data are available. There is one case (Garden & Rothery, 1992) in which a female to male identical twin pair was discordant for transsexuality. Another study showed (Buhrich et al., 1991) that 3/4 identical twins were discordant. These are very small samples, but certainly show that in a significant number of cases transsexuality is enforced neither by genes nor environment..

Neither is the condition unalterable psychologically. Personally known to the author (who has not sought out such cases) are three males who have decided they are not after all women in men’s bodies, and have instead cultivated their masculine side with good success.

This shows that transsexuality is not forced on people by either their environment or their genes. This conclusion is important because it is a fundamental argument of those who seek special rights.

Following the Civil Rights movement in the USA many minority groups sought special rights, but the Federal Supreme Court ruled that it had to be shown a condition was unalterable (like black skin colour) to qualify (Magnuson, 1990). In spite of this social pressures at more local levels have been strong and rights of various kinds have been granted in many cases, which would probably not stand a challenge to the Supreme Court.

Gender studies have resulted in some conclusions that have not become generally known but are relevant to transsexuality. Specifically, the differences between men and women obtained in experiments on masculine or feminine-linked psychological characteristics are almost entirely dependent on the experimental conditions and are small. Thus experiments in which the subjects did not know the purpose of the test gave results in which men were virtually equal to women, whatever trait was measured. If the subjects were told the purpose, the difference increased, and became very large if they were asked to rate themselves for that particular sex-typed trait (Frodi et al., 1977; Eisenberg & Lennon, 1983). The conclusion of these surveys is that natural differences are surprisingly small – often 5-10%, but we want and need to appear different from the other sex so we exaggerate the differences. We do this also for outward adornment, in clothes and accessories. It also occurs for voice pitch. Men speak at a pitch lower than natural for them, women at a pitch higher than natural (Brownmiller, 1984).

This shows that gender characteristics apart from the sheerly physical ones are socially constructed and deliberately cultivated. The data also show that homosexuals and transsexuals are within the normal masculine/feminine range of the trait under study, for their gender. Thus, although they are more feminine than average, they are hugely outnumbered by the heterosexuals who are as feminine as they are (LaTorre, 1979; Bosinski et al., 1997b; Cole et al., 1997; Haslam, 1997). Although transsexuals would like to think of themselves as physiologically different, the differences are within the normal range for their sex, and the belief is clearly psychological.

The question of determinism is philosophically rather stupid. Is an action completely determined by our biology? It cannot be. A genetic tendency to commit genocide could not have any effect unless there was a nation to exterminate. Both biology and outside environment are required. The biological tendency cannot act in a vacuum.

Another interpretation of the phrase is unfortunately ambiguous. “Determination” can mean the action is not deterministic, but has some biological underpinning, which may vary all the way from little to much. The underlying biology influences the behaviour only.

Very few scientists believe that actions by an organism are fixed, fated, inescapable. They talk about nature and nurture and believe that there is some contribution from each.

The debate increasingly centres over what is the relative contribution, and ignores as misinformed the idea that either our genes or our environment force us to do anything.

“..human learning and culture override any relevance biology may have for the explanation of human behaviour.... Biological determinism is what people often think of first when they hear of a biological theory. That’s a shame – because it’s been years if not decades since “biological” has meant “biologically deterministic” ... Men are genetically predisposed to grow hair on their faces, but most American men override that predisposition every morning by performing an unnatural act in front of a mirror” (Weinrich, 1990)

Even the sociobiologists who argue that our genes have an immense influence on our behaviour, do not wish to say they inescapably force us to do anything. E.O. Wilson, the doyen of sociobiologists is at pains to distance himself from this idea. He says that no serious scientist believes this, and although it is sometimes said in the laboratory that certain genes cause a particular behaviour, it is a kind of laboratory shorthand and never meant seriously (Wilson, 1998)

Thus we expect to find numerous connections between the transsexual condition and various biological correlates, but no scientist would expect to find some biological condition which forces a person to become transsexual. The most any paper will be found to argue is that there is a significant influence of the genetic structure or the biological structure on transsexuality as already reviewed.

(A personal perspective of the medical implications.)

There is a debate among medical experts about gender, which has not been resolved and is relevant to transsexuality. This has particularly showed up in cases of intersex children. Which gender should they be raised in? One school of thought has argued that the chromosomal sex should apply. Another, particularly represented by John Money of Johns Hopkins, has argued that other factors such as the wish of the child and parents, the appearance of the child and probable adult hormonal status should be taken into account. Perhaps the most extreme example of this problem (but rare, and the one causing least argument among clinicians) is found in the androgen insensitivity syndrome. A few boys, with a normal XY chromosome pair, none-the-less have a cellular defect in which the cells are completely insensitive to the male hormone (Money & Ehrhardt, 1972).

Thus during development in the womb although testes are formed, the testosterone they secrete has no effect on the developing cells, and the genitalia look feminine when the child is born. There is usually a rather rudimentary vagina. Such children are difficult to differentiate from girls, although sometimes testes may be felt in the groin. Commonly they are brought up as girls. At puberty breasts develop because the cells are sensitive to female sex hormones, and traces of these are secreted by the testes even in normal boys, but their effects are usually completely overwhelmed in normal boys by the male sex hormones.

However menstruation does not start, and the condition is often detected at that point. John Money would recommend they be brought up as girls.

Under his regime, the testes might be removed and the girl placed on hormone replacement therapy thereafter. Surgery would give her a feminine-typical vagina. Even before surgery, the attractions of androgen-insensitive boys raised as girls are to boys. As far as they know, confirmed by what people tell them, they are normal females. So they are attracted to men. If Money’s regime is followed they marry men, lead an apparently normal heterosexual sex life, adopt and raise children successfully, and are relatively normal-appearing women. Attempting a change to live as a very imperfect man is very difficult and likely to lead to considerable emotional problems.

I raise this because it is like a post-surgical transsexual case. It raises a possible moral dilemma. It could be argued that both in androgen insensitivity syndrome and transsexuality two chromosomal XY humans, and therefore by one definition male, may “marry” each other. Some would consider this a homosexual marriage. Ironically, it is already known that at least in the US, if a husband in a marriage undergoes a sex-change operation to female the marriage cannot be annulled on that basis (Scott, 1996), so we have a kind of “lesbian marriage” already sanctioned. This could easily be taken as some kind of legal precedent.

Christians are likely to be divided on the issue of androgen-insensitivity cases. Some would say the marriage of one brought up as a female to another male is an abomination, others would say it is truly an exercise in Christian charity to let a person potentially female marry a male. A sex change operation is going to produce the same difficulty and the same dilemma. A male-to-female transsexual who is chromosomally male, attracted to males, and marries one after an operation is perpetuating a very strange state of affairs.

For the Jews the Law said (apparently very cruelly) that any male with anything defective in his genitalia was not admitted to the temple (Lv 21.20, Dt 23.1). The Law also forbade the confusion of the sexes to the extent that it was not permissible for a man to lie with a man as with a woman, and it was not permissible to cross-dress. Why would laws like these exist? The reason is not given in the Old Testament. From a Christian perspective and considerable hindsight, they may well be in place because earth was intended to mirror heaven – the earthly tabernacle was supposed to mirror the one in heaven and relations between the sexes were supposed to reflect the relation between Christ and his Bride (Eph. 5).

For this reason too, the apparently cruel exclusion law may have an explanation in the mirroring of the heavenly. We may be playing with shadows down here, but even our shadow-theatre is supposed to reflect ultimate realities, and should not add to other confusing shadows.

Thus homosexuality is essentially making a false image of what is in heaven, and is inappropriate.

I am not saying that a post-operative transsexual should be excommunicated! We have all died to the Law and new criteria apply. We are looked on as perfect in the sight of God as far as suitability is concerned. However as far as we can, in our admittedly imperfect state, we are still to model the heavenly as best we can. Paul says that we are not to have sex with a prostitute, not on the basis that this was contrary to the Law, but on the basis that we are parts of Christ and it is a wrong image that they be joined to those of a prostitute. (I Cor. 6).

God forgives what we are, particularly the state we were in when called, but wants us to copy the Heavenly as closely as we can. The sole ethical criterion for acting or judging the appropriateness of actions is certainly not just Christian charity or love. Other factors are very important. This “mirroring” criterion is only one of the grounds for ethics in the New Testament, but the one which is particularly and peculiarly applied to relationships between the sexes. Almost all sex-connected instructions by Paul appeal to this principle, and few others do.

I find myself rather uncomfortable with this principle, because I can see it can lead to many practical and theological difficulties, but we either say Paul is simply wrong, or work through these.

Thus it is arguable that for a Christian, there could be a case for not allowing transsexual operations, marriage, or even marriage of androgen-insensitivity cases.

Such a principle and teaching needs time for individuals and the church to accept because it is not in their consciousness, and mercy should be applied using a capacious dump-truck!. These ethics are explicitly and peculiarly Christian and rely on such a vision of the heavenly, that they should not be expected to be applicable to secular people, whose laws we live under. However among the Christian community, very carefully, I believe we should encourage those with androgen insensitivity syndrome to remain unmarried.

Similarly within the Christian community we should not agree that transsexual operations be allowable for Christians, but at the same time must enter into a huge commitment with a Christian desiring this to work the whole issue through in great depth, and with the best counsel and expertise possible. I believe we should not say “Thou shalt not” unless we say “I’ll carry the burden with you”. Similarly for non-Christians, we should not say “Thou shalt not” unless we are prepared to say “I’ll help you through all the consequences of this difficult decision”.

There is a natural but fragile distaste for same-sex marriage in our secular society. This could be turned to tolerance or even active co-operative propaganda, if a campaign were mounted similar to that for the gay rights movement. People do not know fundamentally why they have this distaste, but a Christian believes that the natural reactions often point beyond this world altogether.

How far this can be expressed in secular law is not clear, but it seems to me more likely that these principles are mainly for Christians to express.

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